Between late March 2015 and June 2015, the study's authors (BUILD staff and consultants) designed and conducted the study to document the different theories of change and practice models among states and localities that are designing and implementing QRIS with the goal of developing a series of composite "theories of change and practice models" that state and localities are employing in the design and implementation of QRIS. To achieve this purpose, this study was designed to achieve the following objectives: 1. Review existing research articles and reports on the design and implementation of QRIS; 2. Analyze publicly available data from and about a sample of states and localities that have designed and implemented QRIS; 3. Conduct telephone interviews with a sample of key informants from a sample of 13 states and localities; 4. Analyze the quantitative and qualitative data; 5. Develop composite theories of change and practice models from an inductive analysis of the data presented by the stakeholders and the accompanying data about the state and local QRIS; and 6. Compile reflections and recommendations from a panel of national, state, local, and provider-level experts regarding the research findings. (author abstract)